Determinación de puntos de corte de gravedad de la enfermedad de Parkinson con la escala de Webster en pacientes atendidos en la consulta de movimientos anormales de la Universidad Nacional

Introducción: La enfermedad de Parkinson (EP) es la segunda enfermedad neurodegenerativa más frecuente y el seguimiento se hace con escalas de clinimetría. La escala de Webster no tiene puntos de corte para determinar la gravedad de la enfermedad. Objetivo: Establecer puntos de corte en la escala Webster para definir la gravedad de la EP en tres grupos: leve, moderada y grave. Métodos: Se revisaron historias recolectadas entre 2008 y 2015. Se dividió la población en tres grupos de gravedad, según la escala Hoehn and Yahr y se compararon los valores de la escala de Webster con la clasificación. Resultados: Se evaluaron 253 pacientes. Se determinaron los puntos de corte en 14 y 18, con sensibilidad y especificidad de 0,5 y 0,93 para el grupo leve y de 0,36 y 0,97 para el grupo grave. Conclusiones: Los grupos de gravedad según W tienen una adecuada especificidad en la clasificación de la gravedad de la enfermedad.Abstract. Introduction: Parkinson’s disease (PD) is the second most common neurodegenerative disease and the follow up is base don clinical rating scales. Webster´s scale does not have defined thresholds to assess the severity of the disease. Objective: To establish cutoff points in Webster’s scale to classify the disease in three groups according to severity. Methods: Clinical records gathered from 2008 to 2015 were analyzed. The study population was divided in three severity groups according to the Hoehn and Yahr progression scale and the scores obtained in the Webster scale were compares to the classification. Results: 253 patients were evaluated. The determined cutoff points of 14 and 18 had sensitivity and specificity of 0.5 and 0.93 for the mild disease group, and 0,36 and 0,97 for the severe disease group. Conclusions: Webster scale severity groups have high specificity in the classification of the disease severity.Otr

Multiple sclerosis management during the COVID-19 pandemic

Altres ajuts: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. The development of standardized data collection as part of routine clinical care through Multiple Sclerosis Partners Advancing Technology and Health Solutions (MS PATHS) was developed and implemented at CC, JH, and CEMCAT in partnership with Biogen. Biogen did not have involvement in study design, data analysis or interpretation, or manuscript preparation.People with multiple sclerosis (MS) may be at higher risk for complications from the 2019 coronavirus (COVID-19) pandemic due to use of immunomodulatory disease modifying therapies (DMTs) and greater need for medical services. To evaluate risk factors for COVID-19 susceptibility and describe the pandemic's impact on healthcare delivery. Surveys sent to MS patients at Cleveland Clinic, Johns Hopkins, and Vall d'Hebron-Centre d'Esclerosi Múltiple de Catalunya in April and May 2020 collected information about comorbidities, DMTs, exposures, COVID-19 testing/outcomes, health behaviors, and disruptions to MS care. There were 3028/10,816 responders. Suspected or confirmed COVID-19 cases were more likely to have a known COVID-19 contact (odds ratio (OR): 4.38; 95% confidence interval (CI): 1.04, 18.54). In multivariable-adjusted models, people who were younger, had to work on site, had a lower education level, and resided in socioeconomically disadvantaged areas were less likely to follow social distancing guidelines. 4.4% reported changes to therapy plans, primarily delays in infusions, and 15.5% a disruption to rehabilitative services. Younger people with lower socioeconomic status required to work on site may be at higher exposure risk and are potential targets for educational intervention and work restrictions to limit exposure. Providers should be mindful of potential infusion delays and MS care disruption

Pruebas funcionales en esclerosis múltiple y su comparabilidad con los valores de administración autónoma: estudio piloto

Introduction. Neurological impairment in multiple sclerosis (MS) is highly variable among patients and over time, making it difficult to quantify. The MS Outcome Assessment Consortium (MSOAC) established sensitive, cost-effective, clinically significant and reproducible measures of different functional systems to be used as outcomes in clinical trials. However, their use in routine clinical care is not widespread due to time and training constraints. Objective. To establish the feasibility of the self-administration of the timed 25-foot walking (T25FW), symbol-digit-modality (SDMT) and 9-peg hole (9HPT) tests in healthy individuals.Materials and methods. We performed a descriptive pilot study. Healthy individuals between 18 and 80 years of age were included. The T25FWT, SDMT and 9PHT (using the dominant [DH] and non-dominant hand [nDH]) were administered by a trained physician, who also instructed the subjects for their self-administration. The correlation and agreement between the guided and self-administered tests were assessed with Pearson\u27s and Spearman’s coefficients and the Bland-Altman method. Results. Thirty-eight healthy volunteers were included. The median age (Q1-Q3) was 36 (23-55) years and 55.26% were female. The correlation coefficient between guided and self-administered tests was 0,37 for T25FW (p = 0,01), 0,54 for SMDT (p < 0,001) and 0,64 and 0,65 for 9HPT in the dominant and non-dominant hands respectively (p < 0,001). Both forms of administration were concordant for T25FW (95%CI of difference: -1,49 to 1,43), 9HPT dominant (95%CI: -5,23 to 4,09 of difference), 9HPT non-dominant (95%CI: -7,75 to 7,14 of difference) and SDMT (95%CI: -20,94 to 24,10 of difference.Conclusions. We provide proof of concept of the feasibility of the self-administration of T25FW, 9HPT and SDMT, as a tool to improve monitoring in routine clinical practice.Introducción. El deterioro neurológico en la esclerosis múltiple (EM) es muy variable entre cada paciente y con el tiempo, dificultando su cuantificación. El Consorcio de desenlaces en EM (MSOAC) estableció medidas clínicas sensibles, costo-efectivas y reproducibles para usar como desenlace en ensayos clínicos. Sin embargo, sus valores de referencia son desconocidos y su uso en la atención habitual no está extendido por limitaciones de tiempo y entrenamiento.Objetivo. Establecer la factibilidad de la auto-administración de las pruebas de marcha de 25 pies (T25FW), test símbolo-dígito (SDMT) y test de nueve hoyos y clavijas (9HPT) en individuos sanos.Materiales y métodos. Realizamos un estudio piloto descriptivo. Se incluyeron individuos sanos entre 18 y 80 años de edad. Las pruebas T25FWT, SDMT y 9HPT fueron aplicadas por un médico capacitado, quien también instruyó a los sujetos para su autoadministración. La correlación y concordancia entre las pruebas guiada y autónoma se evaluó con los coeficientes de Pearson y Spearman y el análisis gráfico de Bland-Altman.Resultados. Se incluyeron 38 voluntarios sanos. La mediana de edad (Q1-Q3) fue de 36 (23-55) años y el 55,26% eran mujeres. El coeficiente de correlación entre las pruebas de administración guiada y autónoma fue de 0,37 para T25FW (p = 0,01), de 0,54 para SMDT (p < 0,001) y 0,64 y 0,65 para 9HPT en las manos dominante y no dominante respectivamente (p < 0,001). Ambas formas de administración fueron concordantes para las pruebas T25FW (IC95% de la diferencia: -1,49 a 1,43), 9HPT dominante (IC95%: -5,23 a 4,09 de la diferencia), 9HPT no dominante (IC95%: -7,75 a 7,14 de la diferencia) y SDMT (IC95%: -20,94 a 24,10 de la diferencia).Conclusiones. Los resultados de este estudio dan paso a la determinación de valores de normalidad poblacional de las pruebas T25FW, 9HPT y SDMT; y establece la posibilidad de su realización de forma autónoma

HLA-DRB1*14 is a protective allele for multiple sclerosis in an admixed Colombian population

Objective: The aim of this study was to determine ancestry informative markers, mitochondrial DNA haplogroups, and the association between HLA-DRB1 alleles and multiple sclerosis (MS) in a group of patients from Bogotá, Colombia. Methods: In this case-control study, genomic DNA was isolated and purified from blood samples. HLA-DRB1 allele genotyping was done using PCR. Mitochondrial hypervariable region 1 was amplified and haplogroups were determined using HaploGrep software. Genomic ancestry was estimated by genotyping a panel of ancestry informative markers. To test the association of HLA polymorphisms and MS, we ran separate multivariate logistic regression models. Bonferroni correction was used to account for multiple regression tests. Results: A total of 100 patients with MS (mean age 40.4 ± 12 years; 70% females) and 200 healthy controls (mean age 37.6 ± 11 years; 83.5% females) were included in the analysis. Ancestry proportions and haplogroup frequencies did not differ between patients and controls. HLA-DRB1*15 was present in 31% of cases and 13.5% of controls, whereas HLA-DRB1*14 was present in 5% of cases and 15.5% of controls. In the multivariate model, HLA-DRB1*15 was significantly associated with MS (odds ratio [OR] = 3.05, p < 0.001), whereas HLA-DRB1*14 was confirmed as a protective factor in our population (OR = 0.16, p = 0.001). Conclusions: This study provides evidence indicating that HLA-DRB1*15 allele confers susceptibility to MS and HLA-DRB1*14 allele exerts resistance to MS in a highly admixed population. This latter finding could partially explain the low prevalence of MS in Bogotá, Colombia

Multiple sclerosis management during the COVID-19 pandemic

Altres ajuts: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. The development of standardized data collection as part of routine clinical care through Multiple Sclerosis Partners Advancing Technology and Health Solutions (MS PATHS) was developed and implemented at CC, JH, and CEMCAT in partnership with Biogen. Biogen did not have involvement in study design, data analysis or interpretation, or manuscript preparation.People with multiple sclerosis (MS) may be at higher risk for complications from the 2019 coronavirus (COVID-19) pandemic due to use of immunomodulatory disease modifying therapies (DMTs) and greater need for medical services. To evaluate risk factors for COVID-19 susceptibility and describe the pandemic's impact on healthcare delivery. Surveys sent to MS patients at Cleveland Clinic, Johns Hopkins, and Vall d'Hebron-Centre d'Esclerosi Múltiple de Catalunya in April and May 2020 collected information about comorbidities, DMTs, exposures, COVID-19 testing/outcomes, health behaviors, and disruptions to MS care. There were 3028/10,816 responders. Suspected or confirmed COVID-19 cases were more likely to have a known COVID-19 contact (odds ratio (OR): 4.38; 95% confidence interval (CI): 1.04, 18.54). In multivariable-adjusted models, people who were younger, had to work on site, had a lower education level, and resided in socioeconomically disadvantaged areas were less likely to follow social distancing guidelines. 4.4% reported changes to therapy plans, primarily delays in infusions, and 15.5% a disruption to rehabilitative services. Younger people with lower socioeconomic status required to work on site may be at higher exposure risk and are potential targets for educational intervention and work restrictions to limit exposure. Providers should be mindful of potential infusion delays and MS care disruption

Humoral and Cellular Responses to SARS-CoV-2 in Convalescent COVID-19 Patients With Multiple Sclerosis

Information about humoral and cellular responses to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and antibody persistence in convalescent (COVID-19) patients with multiple sclerosis (PwMS) is scarce. The objectives of this study were to investigate factors influencing humoral and cellular responses to SARS-CoV-2 and its persistence in convalescent COVID-19 PwMS. This is a retrospective study of confirmed COVID-19 convalescent PwMS identified between February 2020 and May 2021 by SARS-CoV-2 antibody testing. We examined relationships between demographics, MS characteristics, disease-modifying therapy (DMT), and humoral (immunoglobulin G against spike and nucleocapsid proteins) and cellular (interferon-gamma [IFN-γ]) responses to SARS-CoV-2. A total of 121 (83.45%) of 145 PwMS were seropositive, and 25/42 (59.5%) presented a cellular response up to 13.1 months after COVID-19. Anti-CD20-treated patients had lower antibody titers than those under other DMTs (p < 0.001), but severe COVID-19 and a longer time from last infusion increased the likelihood of producing a humoral response. IFN-γ levels did not differ among DMT. Five of 7 (71.4%) anti--CD20-treated seronegative patients had a cellular response. The humoral response persisted for more than 6 months in 41/56(81.13%) PwMS. In multivariate analysis, seropositivity decreased due to anti-CD20 therapy (OR 0.08 [95% CI 0.01-0.55]) and increased in males (OR 3.59 [1.02-12.68]), whereas the cellular response decreased in those with progressive disease (OR 0.04 [0.001-0.88]). No factors were associated with antibody persistence. Humoral and cellular responses to SARS-CoV-2 are present in COVID-19 convalescent PwMS up to 13.10 months after COVID-19. The humoral response decreases under anti-CD20 treatment, although the cellular response can be detected in anti-CD20-treated patients, even in the absence of antibodie